1. Debra Berube MS RNC CIC Director of Infection Control & Prevention St Vincent Hospital Worcester MA

2. C.Diff rates, historical, current, and goals Contact Plus precautions and its implementation Hand Hygiene program rates compliance observations non-compliance Team effort What’s next Brief Outline

3. 2008 SVH C.Diff rate per 10,000 pt days

5. 2008-2010

6. NO FOAM ROOM PLEASE WASH HANDS WITH SOAP AND WATER PRIOR TO LEAVING This NO FOAM sign is posted in addition to Contact Precautions sign Alcohol foam is removed from inside of the patient room Patient and family education Terminal clean upon transfer or discharge

7. Infection Preventionists: Maintain daily list of all patients admitted that have MDRO, history of MDRO, C.Diff. This list includes all other types of isolation as well. Along with staff, maintain appropriate environmental controls Daily rounding on all patients in isolation Patient education oversight of all patients with MDRO including C.Diff. Daily reminder to nursing staff of patient education needs. Patient education brochures: MA DPH, CDC, Krames On-Demand Dissemination of monthly data to all nursing areas Environmental controls

8. Hand Hygiene Program Education upon orientation, annual competencies, as needed Patients, visitors encouraged to wash hands Daily update at morning huddle: current rate, # observations done, days left in the month Movie themed posters: Field of Germs Staph Wars E.G. the Extra-Germestrial etc. Other posters rotated to prevent sign fatigue

9. Hand hygiene monitoring 52 hand hygiene observers each observer has monthly assignment to specific units minimum of 500 observations per month (more is always OK!!!) real-time feedback NO person is exempt from being observed IP cannot observe for statistics IP’s can issue “tickets” if violations are observed by IP’s “Ticket” for attending physicians results in $100 fine per violation, must be paid before allowed to recredential Weekly update sent via email to all observers and leadership team Hand Hygiene Program (continued)

10. Thanks for being a STAR and keeping our patients safe! ♪ You were observed performing Hand Hygiene ♪ Name: _______________________________________ Date: _______________________________________ Observer:_______________________________________ Infection Control Committee: Violation Documentation Form Date of Event: ________________ Location: _______________ Name of Person Observed ___________________________________ Deviation (check all that apply): 1.Was observed not disinfecting hands before / after direct patient contact ______ 2.Was observed not adhering to posted precautions ______ 3. Was observed eating or drinking in patient care area. ______ 4. Was seen inappropriately discarding infectious waste ______ Action: Deviation brought to person’s attention Yes No Comment: ________________________________________________________ _________________________________________________________ Name of person completing form:_________________________ Approved by SVH Infection Control Committee July 2008

11. Always Foam OUT Save Lives Clean Hands Always Foam IN Small magnetized signs that are posted at every patient doorway

14. Decrease hospital acquired C.Diff by 25% by the end of 2011 Continue to engage front line staff Increase patient education regarding: C.Diff, transmission, prevention Increase hand hygiene rates Maintain and increase effective environmental cleaning Bleach wipes in ICU and other areas when appropriate Cleaning is everyone's responsibility, not just “housekeeping” Maintain IP visibility on patient care units Increase antibiotic stewardship Goals:

15. Team Effort All staff are responsible for patient safety Infection prevention is patient safety Safety trumps all!!! Take away messages: Wash, Wash, Wash (both hands and surfaces) Include all clinical disciplines in the prevention of infection Cleaning is everyone's responsibility, not just “housekeeping” If something isn’t working, then step back and look at the big and little picture again. Use rapid cycle PDSA (plan, do, study, act) Reach out for help!! Either on a unit, supervisor, another discipline, another facility.............include all appropriate disciplines

16. Questions???